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The Health Wrap: beyond the headlines on COVID, exercise and the elderly, and an incredible giveaway

Introduction by Croakey: The recent declaration by United States President Joe Biden that “the pandemic is over” caught many by surprise, and has been criticised for “seeming to play politics with public health”.

As global health expert Professor Gavin Yamey wrote in Time magazine, the COVID pandemic is far from over but the President’s apparently unilateral declaration highlights that the ending of any pandemic is not determined solely by science or public health data, but involves social and political considerations, and that it does not come in a moment but as a process – “one that can be messy and highly contested”.

In Australia, where public debate about COVID remains messy and contested, Federal Health Minister Mark Butler made clear this week that COVID is not over, signalling the need for ongoing investment and programs well into next year. Announcing $1.4 billion to extend COVID-19 response measures, he also highlighted the current and future toll of Long COVID.

Butler said $42 million would be invested in community campaigns for the rest of this year and the first half of 2023, with targeted campaigns for First Nations communities. He was also keen “to explore the way in which we can target communications campaigns better to culturally and linguistically diverse communities to make sure that those communities are given the fullest possible information about their choices around vaccines, around treatments, and around good COVID-safe behaviour in their communities”.

Governments’ commitment to prevention, however, is far from clear; the Australian Medical Association today said it was disappointed by state governments’ decision to drop mask mandates on public transport without notice, clear guidance or public health advice.

AMA President Professor Steve Robson said governments were continuing to make serious decisions with no consultation and no discussion about how to prepare for the consequences. NSW and South Australia will now join the ACT, Western Australia, Northern Territory and Tasmania in not requiring public transport passengers to mask-up.

“This is a major decision which will have consequences and it should have been done with national consensus and clear health guidance,” he said in a statement. “Many of our most vulnerable people in the community are the ones that use public transport the most. Masks are the last of the sensible protections and we urge people not to abandon using them.”

Meanwhile, in the latest edition of The Health Wrap, Adjunct Associate Professor Lesley Russell reviews wider pandemic developments, new evidence on the benefits of physical activity for healthy ageing and some incredible corporate leadership. (Editor’s note: This column was filed before Minister Butler’s announcement on 19 September).


Lesley Russell writes:

New reports and data highlight that Australia is not on top of the COVID-19 pandemic. As my Croakey colleague Dr Amy Coopes wrote recently, National Cabinet has acted to reduce COVID-19 protections, even as new data reveal the pandemic death toll.

The latest bulletin from the Australian Health Protection Principal Committee (AHPPC) regarding a reduced isolation period for those with COVID-19 is headed as noting “the need for a proportionate approach to isolation for those with COVID‑19 infections at this stage of the pandemic”.

But a “proportionate approach” seems to be “let it rip” and the inevitable effect is that people are dying. Last week there were some 250 deaths from COVID-19 – and a move to reporting the statistics weekly does not make the numbers any better.

Sadly, despite expectations, the Albanese Government does not seem to be doing any better than the former Coalition Government in terms of tackling infections in residential aged care, getting boosters shots into arms, and persuading Australians that ongoing individual and community safeguards against infection are still needed.

New reports also highlight the gaps in data collection. To be blunt, Australia does a lousy job of collecting useful COVID-19 data (ie information that could help with better targeting vaccination and information programs) about culture, language, race and ethnicity.

There is plenty of scope here for the recently established parliamentary investigation, despite its specific focus on long-COVID and repeat COVID-19 infections.  Or maybe we need a Royal Commission and a full-scale inquiry?

Eminent researchers from the Burnet Institute make the case in an article published in The Conversation that what’s needed is a shared vision and a strategic COVID plan that acknowledges it is not “just like the flu”.

Newly elected Teal parliamentarian Dr Monique Ryan has called on the Federal Government to rethink pandemic management and has called for a national summit.


Australian Institute of Health and Welfare report

A new report from the Australian Institute of Health and Welfare – The Impact of a new disease: COVID-19 from 2020, 2021 and into 2022 – and additional, more recent, Australian and international data boost my criticisms.

1. By 30 April 2022, the cumulative incidence of COVID-19 was 231,000 cases per million people and the number of reported deaths was 5335; 3107 of these were in 2022. The number of reported deaths here seems very low – the WHO data says 7,225 deaths by 25 April, 2022.

Updates highlight the dreadful impact of “opening up”:

  • WHO reports that on 13 September Australia had a cumulative total of 36,656 confirmed cases per 100,000 people, ranking it among the very worst internationally. The American cumulative total was 28,398 cases per 100,000 people – although under-reporting is likely worse in the United States.
  • The Department of Health (DoH) website is reporting 14,421 deaths by 9 September (the WHO reports a similar number) – an appalling increase since April. However, the death rate in Australia is much better than that for most other developed countries. For example, WHO reports the Australian death rate at 56.5 cases per 100,000 compared to the United States at 314.1 cases per 100,000. I’m not sure we should regard this as a consolation, but it does highlight how well our public healthcare system has performed under very difficult circumstances.

2. The AIHW is curiously low-key on reporting the residential aged care data, and gives this only for 2020, when 75 percent of all aged care deaths were residents of aged care facilities.

More recent information highlights that the rates of COVID-19 infection and death in aged care are still high:

  • The most recent weekly report on the DoH website for the week of 2 September to 9 September shows that there were 11456 new cases of COVID-19 in residents and staff and 53 resident deaths.
  • The rates of both are (finally) trending down, after peaks in August, April- May and January. So far in 2022 (to 9 September) there have been 3116 deaths from COVID-19 in aged care facilities – curiously reported by DoH as 6.5 percent of total deaths (47,937), as if they can’t they bring themselves to face reality! The reality is very tough: the deaths so far in 2022 are more than triple those in both 2020 (when we were so appalled at 686 deaths) and 2021 (231 deaths).
  • In 2020, more than 33 percent of COVID-19 cases in residents resulted in deaths, but this has dropped to 3.5 percent in 2022. 81.6 percent of eligible residents have now had their fourth vaccine dose.

Let’s hope the recently-established parliamentary inquiry will be looking at the adequacy of the Albanese Government’s winter plan for aged care homes.

3. The rate of severe disease during the Omicron wave (figures are to 3 July 2022) for Indigenous people was 1.4 times as high as for non-Indigenous Australians.

  • Additional reporting on the impact of the pandemic on Aboriginal and Torres Strait Islander people is hard to find. There is some information in the regularly-produced Communicable Disease Intelligence reports.
  • In the entire Omicron wave to 31 July 2022 (the most recent report), there were 247,300 cases of COVID-19 notified in Aboriginal and Torres Strait Islander people, representing 3 percent of all reported cases. Almost half (104,060) of these cases were in New South Wales and only 27, 907 of the total cases were in remote communities.

4. Nationally, 212 COVID-19 deaths have been reported in Aboriginal and Torres Strait Islander people from the start of the pandemic to 31 July 2022.

People from lower socio-economic groups and those born overseas, especially in North Africa and the Middle East, had higher COVID-19 mortality rates than other Australian residents.

The Australian Bureau of Statistics (ABS) has information of COVID-19 deaths by country of birth.

  • The most recent ABS data (to 30 June 2022) show that those who died of COVID-19 with a country of birth of overseas, had an age-standardised death rate two times higher than that of people who were born in Australia (15.6 deaths per 100,000 people versus 7.6 deaths).
  • Those with a country of birth in the Middle East had the highest age-standardised death rate at 46.9 deaths per 100,000 people.
Tweet dated 3 September

Report from New South Wales Ombudsman

The second report on the COVID-19 pandemic from the NSW Ombudsman was recently released. This looks at the second year (2021-2022) of the pandemic through the lens of complaints to the Ombudsman about actions taken by NSW Government agencies. The first report is available here.

It makes very interesting reading. My summary of what I see as the key points follows.

  • Complaints related to COVID-19 were 125 percent higher in 2021-22 than in 2020-2021 (1,046 vs 463). The biggest increase in complaints was in the custodial system. There were 436 complaints about mandatory hotel quarantine which was phased out in late 2021.
  • The report makes the case that “a visible, accessible and properly functioning complaint-handling system is particularly important during a pandemic” when parliamentary governance and oversight may be sidelined in favour of emergency executive powers used to “impose significant and unusual incursions on individual rights.”
  • The primary tool the NSW State Government used to implement its pandemic response was not the standard model of law-making (parliamentary acts and regulations) but public health orders made usually by the Minister for Health under the state’s Public Health Act.
  • Directions made under such an order are reviewable, but the decision to make a public health order is not. This is the norm in all Australian jurisdictions (helps explain why Morrison wanted to be federal Minister for Health).
  • In NSW, the sheer number of state public health orders, and the frequency with which they were modified, made it difficult for individuals and businesses to know what was required of them. The order were published only in English and were often lengthy and legally complex. There was confusion between rules (hard laws) and guidance (soft laws).

The Ombudsman made the following points about these rules:

  • There was not a lot of common-sense in the rules (eg the rationale behind the limit on the number of people who could visit a house was not obvious).
  • Some of the rules were not enforceable (eg the requirement to report a positive rapid antigen test).
  • There was a disproportionate number of enforcement actions in those Local Government Areas that are home to marginalised communities, including Aboriginal and Torres Strait Islander people and CALD populations.
  • Penalties were not always proportional to the rule-breaking offence and even children were fined.

In the previous report, the Ombudsman had made the case that the current oversight and complaint-handling system is not well-suited to the issues around the COVID-19 pandemic and suggestions were made for improvements. The NSW Government has not yet taken steps to implement these.